第七章队列研究.ppt

发病率研究 纵向研究 随访研究 前瞻性研究 概述 实例 研究设计与实施 资料的整理与分析 偏倚及控制 优缺点 队列研究简史 定义与目的 原理与类型 History of cohort study Definition and Purpose Principle and Types 历史 History 起源 Origins Graunt (17th century) used cross-sectional mortality data to reconstruct life history using life-table methods Graunt (17世纪) 用横断面死亡资料，用寿命表方法构建生命史 Farr (19th century) advanced the use of life-table methods a an indicator of population health Farr （19 世纪）将寿命表方法发展为人群健康的指标 Insurance industry study 1870 – 1899 保险业研究1870 – 1899 Tuberculosis (20th century) 结核（20世纪） WH Frost performed the first retrospective cohort study in a cohort of 132 homes with tuberculosis WH Frost 在有结核的132个家庭的队列开展第一个回顾性队列研究 Used person-years to estimate attack rates 用人年来估计罹患率 WH Frost initiated prospective cohort study of tuberculosis in Williamson county, Tennessee WH Frost 在德州启动有关结核的前瞻性队列研究 Framingham study of cardiovascular disease, 1948 Japanese atomic bomb survivors, 1946 British physician study, 1950s Colorado Plateau uranium miners, 1950s Nurses Health study, 1976 to present British physician study Multi-center AIDS Cohort Study MACS, 1984 – 1999 Cohort Study Begin with disease-free patients Classify patients as exposed/unexposed Record outcomes in both groups Compare outcomes using relative risk 从没有疾病人群开始 将研究对象分为暴露与非暴露组 记录两组结局 用相对危险度比较结果 队列 拉丁语原意是指古罗马军团中的一个分队 一组人群 有共同经历 随访一特定时间 例如 出生队列 职业队列 暴露 指接触过某种物质、具备某种特征或处于某种状态。 危险因素 泛指能引起某特定不良结局,或使其发生的概率增加的因子，包括个人行为、生活方式、环境和遗传等多方面的因素。 Exposure contact some material of being in some status Risk factor is a variable associated with an increased risk of disease or infection. Including behavior, life style, environmental and genetic factor and so on. 描述随着时间变化结果的发生率，疾病自然史 确定结果与暴露（危险或预后）因素间的因果关系 目的 Purpose Determine a prognosis Evaluate new therapies and diagnostics Evaluate screening procedures 确定预后 评价新的治疗与诊断方法 评价筛检过程 观察性研究 根据暴露分组 需要对照 前瞻性 类型 Types Based on recruit time of study subject Prospective study v.s. Retrospective Study Based on the type of c